POS1335 ADHERENCE TO COLCHICINE PROPHYLAXIS AMONG PATIENT WITH FAMILIAL MEDITERRANEAN FEVER TREATED WITH INTERLEUKIN-1 INHIBITORS
Authors: Y. Levinsky, G. Amarilyo
Journal: Annals of the Rheumatic Diseases (2022)

Background Colchicine is the only drug proven to prevent secondary amyloidosis among familial Mediterranean Fever (FMF) patients. Therefore, the common recommendation is to continue colchicine during the treatment with IL-1 inhibitors, despite clinical remission. Objectives Our aim was to estimate the adherence to colchicine among FMF patient treated with IL-1 inhibitors. Methods The databases of Maccabi Health Services (MHS), a 2.6 million member state-mandated health provider in Israel was searched for patients with FMF diagnosis. Medication possession ratio (MPR) was used as main outcome measure. Patients treated with IL-1 inhibitors (“combination group”) were matched in a ratio of 1:4 to patients on colchicine only (“single treatment”). In the second phase, patients with IL-1 inhibitors were matched to themselves, before and after starting the treatment. Results The final cohort included 4526 patients. Among them, 108 patients were treated with IL-1 inhibitors. They were matched to 432 “single treatment” patients. The total MPR in each groups was similar (78.9 ±41.4 versus 82.5 ± 80.6, P=0.5). In sub-analyses females treated with IL-1 inhibitors had less MPR than in the matched group (81.4 ± 33.2 versus 85.1 ± 91, P=0.03). In the second phase, The MPR was higher after starting IL-inhibitors among the total population (19.7±13.1 before versus 32.2±14.5 after, p&lt;0.01). Conclusion Contrary to initial concerns, the adherence to colchicine is excellent among patients treated with IL-1 inhibitors and is similar to the general FMF population. Moreover, the adherence increases among the same patients after starting IL-1 inhibitors, which may reflect the improvement in disease perception following the need to start the biological treatment. References [1]El Hasbani G, Jawad A, Uthman I. Update on the management of colchicine resistant Familial Mediterranean Fever (FMF). Orphanet J Rare Dis. 2019 Oct 15;14(1):224. [2]Sag E, Akal F, Atalay E, Akca UK, Demir S, Demirel D, Batu ED, Bilginer Y, Ozen S. Anti-IL1 treatment in colchicine-resistant paediatric FMF patients: real life data from the HELIOS registry. Rheumatology (Oxford). 2020 Nov 1;59(11):3324-3329. [3]Marko L, Shemer A, Lidar M, Grossman C, Druyan A, Livneh A, Kivity S. Anakinra for colchicine refractory familial Mediterranean fever: a cohort of 44 patients. Rheumatology (Oxford). 2021 Jun 18;60(6):2878-2883. [4]Tekgöz E, Çolak S, Çinar FI, Yilmaz S, Çinar M. Non-adherence to colchicine treatment is a common misevaluation in familial Mediterranean fever. Turk J Med Sci. 2021 Oct 21;51(5):2357-2363. [5]Ben-Chetrit E, Ozdogan H. Non-response to colchicine in FMF--definition, causes and suggested solutions. Clin Exp Rheumatol. 2008 Jul-Aug;26(4 Suppl 50):S49-51. [6]Yücel BB, Aydog O, Nalcacioglu H, Yilmaz A. Effectiveness of Canakinumab Treatment in Colchicine Resistant Familial Mediterranean Fever Cases. Front Pediatr. 2021 Sep Table 1. Comparison of medication possession ratio (MPR) of colchicine between FMF patients treated with IL-1 inhibitors Versus patients without IL-1 inhibitors treatment Parameter With IL-1 inhibitors – “study group” (n=108) Without IL-1 inhibitors – “matched group” (N=432) P-value Age category, years ≤6 74.9±24.9 (N=32) 75.8±33.7 (N=23) 0.9 7-14 90.2±53.6 (N=24) 75.6±70.3 (N=93) 0.09 15-29 76.5±47.9 (N=29) 91.1±123.3 (N=101) 0.3 ≥30 75.8±33.7 (N=23) 77±49.9 (N=112) 0.6 Sex Male 75.7±49.9 (N=48) 79.2± 65.5 (N=192) 0.9 Female 81.4±33.2 (N=60) 85.1±91.0 (N=240) 0.03 Time of colchicine use &lt; 8 years 102.8±46.2 (N=42) 100.9±99.5 (N=245) 0.2 8-15 years 66.6±35.8 (N=26) 56.7±36.5 (N=103) 0.2 &gt; 15 years 61.9±24.8 (N=40) 60.4±25.8 (N=84) 0.7 Disclosure of Interests None declared